AB0280 PREGNANCY, BIRTH OUTCOMES, AND BREASTFEEDING IN CHRONIC RHEUMATIC DISEASES WOMEN
Authors: K. Maatallah, L. Kharrat, H. Ferjani, D. Ben Nessib, D. Kaffel, W. Hamdi
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Parenthood is usually challenging in chronic rheumatic diseases, such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). It seems to be affected by the disease state and pharmacological therapies [1,2]. <h3>Objectives</h3> We aimed to assess pregnancy, birth, and breastfeeding outcomes in patients with RA and SpA. <h3>Methods</h3> We conducted a cross-sectional study including patients followed for RA or SpA. We collected the following data: age, disease duration, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels, disease activity was assessed using DAS28 score for patients with RA and ASDAS-CRP scores for patients with SpA. We asked patients about their pregnancies, birth outcomes, and breastfeeding. Statistical analysis was performed using SPSS software. <h3>Results</h3> Forty-six women were included. They were 23 RA patients and 23 SpA patients. The mean age was 50.2 ± 13.1 years. The mean disease duration was 9.64 ± 8.27 years. The mean ESR and CRP levels were 40.45 ± 33.12mm and 15.22 ± 24.21 mg/L. The mean DAS28-ESR and ASDAS-CRP were 5.25 + 1.21 and 2.7 + 0.6, respectively. Forty-one women were married, 3 were divorced and 2 were widows. The mean age at the marriage was 24.9 + 6.66 years. Half of the patients had suffered from infertility (n=23). Eight of them never had kids (17%). The mean numbers of gestation and parity were 3 + 2 [0-7] and 2+ 1 [0-6], respectively. Seven patients discontinued their treatment to get pregnant without discussing it with their rheumatologists (15%). Only 6 patients had complications during their pregnancies (16%). Complications were abortion in 5 cases and preeclampsia with premature birth in one case. Twenty-five patients gave natural vaginal birth (66%), 7 patients gave birth by C-section (18%), and 6 patients needed obstetrical forceps to give birth (16%). Two patients had a post-partum hemorrhage. The mean term birth was 39.18 ± 1.44 weeks of amenorrhea. Thirty-four patients had breastfed the children (74%). The mean breastfeeding duration was 13.76 ± 8.8 months. Eight patients reported impairment of breastfeeding due to their diseases (21%). Birth with cesarean section was associated with a younger age at the onset of the disease (32.75 ± 5.73 vs 43.16 ± 10.3 years, p=0.031). DAS28-ESR and ASDAS-CRP were higher in patients who had cesarean section but the difference was not significant (DAS28: 5.12 ± 0.45 vs 4.34 ± 0.79, p=0.08; ASDAS: 3.04 ± 0.9 vs 2.59 ± 0.6, p=0.3). Furthermore, younger age was associated with impaired breastfeeding (39.4 ± 9.23 vs 56.11 ± 11.27 years, p=0.01). Discontinuing the treatment was associated with infertility (p=0.003), a younger age of the patient (40.8 ± 7.82 vs 51.33 ± 14.47 years, p=0.002), older age at the marriage (34 ± 6 vs 23.21 ± 5.02 years, p=0.042), and higher CRP (22.08 ± 27.58 vs 8.18 ± 8.36 mg/L, p=0.04). <h3>Conclusion</h3> Our results are consistent with other studies [2], caesarean section rates seem to be high in RA and SpA patients [3]. Strikingly, our youngest patients were the ones that discontinued their treatment to get pregnant. This highlights the importance of informing and discussing pregnancy with patients with chronic inflammatory diseases. <h3>References</h3> [1] Krause ML, Makol A. Management of rheumatoid arthritis during pregnancy: challenges and solutions. <i>Open Access Rheumatol</i>. 2016;8:23-36. [2] Hamroun S, Hamroun A, Bigna JJ, Allado E, Förger F, Molto A. Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis. <i>Rheumatology (Oxford</i>). 2022;61(4):1314-1327. [3] Carter ED, Walker PN. Estimating c-section coverage: Assessing method performance and characterizing variations in coverage. <i>J Glob Health</i>. 2022;12:08002. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.